Individual
MR. DAVID KENNETH JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ABOC
Contact information
Practice address
4200 ELDERON AVE, BALTIMORE, MD 21215-4802
(410) 664-4508
(410) 664-0605
Mailing address
4200 ELDERON AVE, BALTIMORE, MD 21215-4802
(410) 664-4508
(410) 664-0605
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
072195
MD
Other
Enumeration date
04/24/2008
Last updated
04/24/2008
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